^(18)F-FDG PET/CT心肌代谢显像评价冠状动脉慢性闭塞性病变存活心肌及与侧枝循环形成的相关性

The correlation study of left ventricular viable myocardium detected by ^(18)F-FDG PET/CT and coronary collateral circulation in patients with chronic total occlusion lesions

目的:冠状动脉慢性闭塞性病变(CTO)患者行^(18)F-FDG PET/CT心肌葡萄糖代谢显像,检测左心室存活心肌的部位、范围和程度,评估其与侧枝循环形成的关系。方法:入选CTO患者60例,1周内分别完成^(99mTc-MIBI)静息门控心肌灌注SPECT/CT(GSPECT)断层显像和^(18)F-FDG门控心肌葡萄糖代谢PET/CT显像(GPET)评价左心室存活心肌及左心室整体功能,冠状动脉造影评价CTO病变的位置、血管数量及侧枝循环形成。GPET数据采用定量门控心脏断层软件QGS分析,获取左心室功能参数,舒张末期容积(EDV),收缩末期容积(ESV)和左心室射血分数(LVEF)。侧枝循环形成的程度应用Rentrop分级评价。比较CTO患者中侧枝循环形成不同的患者存活心肌的部位、范围及左心室功能参数之间的差异。结果:CTO患者Rentrop分级不同的患者中,侧枝循环良好组(RentropⅡ和RentropⅢ)患者的心肌血流灌注优于侧枝循环不良组(RentropⅠ和Rentrop 0级),但是侧枝循环良好组与侧枝循环不良组患者^(18)F-FDG PET/CT评价的存活心肌的范围及左心室整体功能和重构状态未见明显差异。侧枝循环形成与心肌梗死区域存活心肌的范围不具有"一一对应"的关系,在侧枝循环良好组,有10%的患者存活心肌面积≤10%,通过血运重建术开通闭塞血管后,预估患者的临床获益小;而在侧枝循环不良组,仍有10%的患者存活心肌的面积>10%,通过血运重建术开通闭塞血管后,患者心肌血流灌注改善,心功能恢复较好,患者能够获得较好的临床预后。结论:CTO病变患者心肌存活范围与左心室射血分数与侧枝循环形成不具有明显的相关关系,在进行介入及搭桥血运重建术前,综合评级存活心肌的部位、范围及冠状动脉侧枝循环形成,能够为患者制定个体化的治疗方案,最大限度的改善患者的预后,有重要的临床价值。

Objective： ^18F-FDG PET myocardial metabolism imaging was performed to evaluate the location,extent of viable myocardial of CTO lesions and then analyzed the correlation of viable myocardial and coronary collateral circulation(CCC）. Methods： Sixty consecutive patients with CTO lesion referred for viability assessment,who were studied with ^99mTc-sestamibi ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated ^18F-FDG PET/CT myocardial metabolic imaging,and coronary arteriography were recruited in our study. LV functional parameters(EDV,ESV,and LVEF） were analyzed by QGS software. The extent of CCC to the area of CTO related artery was graded as poorly(n = 16）,or well(n = 44） developed collaterals,assessed by Rentrop classification. Further,relationship between CCC and LV functional parameters,viability information was analyzed by univariate analysis. Results： Univariate analysis showed that no statistically difference between Rentrop groups of CCC and the extent of viability myocardial. Although there are more patients with the extent of viable myocardial more than 10% in well CCC group with Rentrop Ⅲ grade patients,Which indicated that after the CTO lesion has been opened by PCI could obtain a good prognosis. Conclusion： There is no significant correlation between the extent of viability myocardial and CCC. So the evaluation of the extent of viability before the vascular intervention is necessary and very important to get a reasonable treatment and a good prognosis for patients with CTO lesions.